Provider Demographics
NPI:1114501715
Name:VALLEY MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:VALLEY MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHADOORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-801-5844
Mailing Address - Street 1:5627 N FIGARDEN DR STE 118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3498
Mailing Address - Country:US
Mailing Address - Phone:559-284-1227
Mailing Address - Fax:
Practice Address - Street 1:5627 N FIGARDEN DR STE 118
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3498
Practice Address - Country:US
Practice Address - Phone:559-284-1227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487634317Medicaid